Thursday, 20 February 2014

Information On ICD-10-PCS And Need For Early Compliance

By Violet Solomon


The International Classification of Disease 10th revision Procedure Coding System is normally abbreviated as ICD-10-PCS. This is a system of medical classification that helps to procedurally give coding to health interventions that the medical professionals may choose. The World Health Organization normally publishes PCS so as to track the international morbidity and the mortality statistics for comparison.

The first digit of this code is used to indicate the section of the medical practice. This can be surgery, administration, monitoring, measuring or many others. The second code is for body system, third for root operation, fourth for body part, the fifth for approach and sixth for the medical devices. The last digit is the qualifying code. Given the importance of the first three characters, they are stored in ICD manual for reference purpose.

The ICD-10 came as a replacement of the ICD-9 and is set to take effect on October 1, 2014 bringing with it a dramatic change in medical and healthcare sector in general. All the players from federal government, state governments, medical professionals and the insurance firms are set to be affected by this new coding system.

With the implementation of ICD-10 coding system, the hospitals are expected to have 87, 000 new codes for all in-patient procedure coding replacing the existing 8,660 CPT codes. The replacement however takes place for the in-patient procedures only. The new codes are not applicable for billing the radiologist components and out-patient services, procedures and studies. The implication is that identical procures are described by CPT codes for out-patients but with ICD-10 for in-patients.

The auto insurance industry, legal claims and workers comps will not be converting to the new ICD-10 codes forcing hospitals to provide a mixture of CPT, ICD-9, ICD-10 and ICD-10-PCS in general management and billing system. For this reason, every player should have the capacity, ability and knowledge on when to and how to automatically convert from one coding system to the other and back. This should also be done with ease, efficiency and comfort as much as possible.

As a healthcare provider in US, it is important to be fully compliant with the new coding system long before the October 1, 2014; the date of transition comes. This helps avoid the challenges associated with late attempts to comply such confusion and delays that are likely to be witnessed as there will be a rush from hospitals, surgery centers, clinics, CMS, insurance firms and State Medicaid and other players.

If you choose the option of upgrading the system as required, there are a few challenges that you need to prepare for as suggested by studies done on countries that have already converted to the new coding system. These include increased time per claim for coders, need to additional staff, concurrent processing of ICD-9, 10 and the new in-patient code, disruption of reimbursements and possible backlog of programming requests.

There are several benefits that come with early compliance such as being able to avoid confusion and delays as all other players seek to comply at last minute. In fact, this is likely to cause system backlogs. The transition to the ICD-10-PCS may not be as smooth as expected especially if the rumors and concerns arising are not fully addressed. The major concern comes from rumors that unspecific codes will be eliminated making it impossible to make claims for the related complications.




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